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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Utilization Management Nurse

Primary Location: High Point, North Carolina
Additional Locations: NC-High Point
Are you ready to expand your nursing into overall member health, aiding in the reduction of hospital readmissions and helping patients get back to their daily life?
How about dipping your toes into population health nursing and impacting the lives of patients, far beyond the limited interactions you have now?

As an Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Looking for someone who enjoys working in an office in a high energy and motivated team environment and is detail oriented and highly organized.

This role is located in the High Point, NC office and will require being in the office at least the first 12-18 months. This is a dynamic and passionate team, with much support! This position is in an office environment using a computer station and may require sitting for extended periods of time. - Candidate must possess computer and typing skills. - This is ideal for an applicant seeking a fast paced environment. Full Time positions with business hours, Monday through Friday. To service west coast customers, nurses will be required to work 2-3 times a month until 9:00pm EST after training. Saturday work required after 6 months of training, 1-2 Saturdays per quarter can be expected, to meet federal and state regulated turn-around times. The office is located at 4050 Piedmont Parkway, High Point, NC. Work from home opportunities may be available after 12-18 months of employment, determined by business need.

Minimum of 3+ years of clinical experience (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more!)
Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills.
Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills.
Ability to manage multiple priorities, effective organizational and time management skills.
This position is in an office environment using a computer station and may require sitting for extended periods of time.
Any managed care background is a plus.
Utilization Review experience preferred but not required

The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.

Nursing/Registered Nurse (RN) is RN required, unrestricted and active

Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years

Technical - Operating Systems/Windows/1-3+ Years/End User

Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED

Telework Specifications:
Work from home opportunities may be available after 12-18 months of employment, determined by business need.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Fundamental Components:

Fundamental Components but not limited to the following:
They accomplish this by completing the following activities:
-Gathers clinical information and applies the appropriate policy, procedure and clinical judgment to render coverage recommendation along the continuum of care
-Begins proactive discharge planning to facilitate safe and effective transitions to the next level of care, such as home or alternate discharge location.
-Communicates with providers and other parties to facilitate care/treatment, demonstrating superior customer service skills -Identifies members for referral opportunities to integrate with other products, services and/or programs
-Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization -Lends expertise to other internal and external constituents in the coordination and administration of the utilization management / benefit management function.
-This is a quick paced position that requires timeliness standards are met.
-All patient/provider contact is via phone or electronic media.

Background Experience:

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:

Click To Review Our Benefits (PDF)


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